Imaging and Resection

Travis Menge, MD (Grand Rapids, MI), demonstrates an arthroscopic cam resection using a curved hip burr, the ApolloRF® H50 probe, and DualWave™ outflow tubing.

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VID1-001919-en-US | A | Cam Resection Using a Curved Hip Burr, the ApolloRF® H50 Probe, and DualWave™ Outflow Tubing

Travis Menge

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Cam Resection Using a Curved Hip Burr, the ApolloRF® H50 Probe, and DualWave™ Outflow Tubing

My name is Doctor Travis Menge from Grand Rapids, Michigan, and today we're looking at a right hip for an arthroscopic camera section and femoral plasty. We're viewing through the mid anterior portal and we're working through our anterolateral portal. As you can see, we've got a large cam lesion looking from anterior to posterior. I typically start off using the H50 RF wand to help delineate where the extent of my cam is. Again, from a posterior to anterior direction, this wand allows me to retract the distal leaflet of the capsule and evaluate the extent of the Cam lesion without removing excessive tissue from the capsular tissue. To get the appropriate visualization, once I identify where the Cam lesion is, I typically will use the h50 RF to debride and remove some of the overlying cartilage or fibrous tissue that is often covering the Cam lesion. And again you can see this large Cam lesion. And this h50 RF wand does a great job in helping you outline the extent of the Cam deformity. Once we've identified and outlined our Cam lesion and the area of resection I'll use the curved shaver. The Torpedo to gently remove some of the edges of our capsule while maintaining the surrounding normal, healthy tissue for later capsular repair. What's great about this Torpedo is number one. The curved angle allows you to reach posteriorly as well, as it's a very precise and accurate resection. You can see we're cleaning up the edges of that capsule, but we're not removing or debriding an excessive amount of capsular tissue, which could compromise our capsular repair at the end of the case. Additionally, the tapered nose of this blade allows me to accurately resect the tissue that I would like to without causing excessive resection of the surrounding healthy tissue. We're now using a 5.0mm curved bur to address and resect this cam deformity. What's great about the curvature of this bur is that it really allows you to work posteriorly, and especially posterolateral, where sometimes it's difficult to access and you can create a nice resection. Again, working from a more posterior to anterior direction as you recreate the normal offset of the femoral head and neck junction. Another great tip with this bur is you is you can change how aggressive you'd like to resect by either using forward, which is more aggressive, or reverse on the foot pedal, which is going to be more of a polishing type resection. So to start off, I'll typically use a more aggressive resection with forward as we outline and resect this cam deformity. And the curved burr has a unique advantage of allowing you not only to access that posterior cam, but also the anterior cam much better than a straight burr. Another benefit with the curved burr is you spend less time switching portals as you're working on resecting a cam, especially large cam, where you often have to switch portals multiple times throughout the case. As you can see with the curved burr, as we're working on that margin to reshape that femoral head neck junction, you get excellent contouring with very precise removal of that cam deformity as we work more posterior and posterolateral. This burr allows you to access a lot of that cam that you'd have a hard time normally accessing with a straight burr. And often I'll switch between our h50 RF wand to work posteriorly and posterolateral as we debride the fibrous tissue covering the cam lesion, and as we continue to work more posteriorly, we want to internally rotate the foot and bring the leg into extension to help access that area. Now we're going to switch back to the curved bur. You can see how this curve allows you to work posteriorly and get the hard to reach areas of a large cam. Now the bone on this cadaver is very soft, but you can see the accessibility that you get with this curved bur compared to a straight bur. Additionally, the DualWave outflow is keeping our visualization clean throughout the resection and allowing an optimal resection with minimal debris blocking our view. As you can see, the curved bur is resecting the bone very nicely and allowing access as we move anterior in the hip. Here we are with completion of our camera section. Using the curved bur, you can see the access that the bur gave us to go all the way posterior as we work anteriorly as well. You can see that labrum is repaired very nicely, and we've got a great suction seal between the labrum and the femoral cartilage.

Cam Resection Using a Curved Hip Burr, the Apollo^RF® H50 Probe, and DualWave™ Outflow Tubing

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